Blunt diaphragmatic lesions: Imaging findings and pitfalls

Figure 14 Effects of mechanical ventilation on blunt diaphragmatic lesions. The antero-posterior chest X-ray, performed immediately after intubation and left pneumothorax drainage (A) in a patient admitted to the ED because of severe motorbike accident, showed a double left diaphragmatic profile (circle), suspicious for BDI. The finding was not confirmed at the subsequent CT, performed after the beginning of positive-pressure ventilation, and also the CXR performed 2 d later, after pleural drainage removal (B) did not show any diaphragm alteration. Three days later, after estubation, the patient suffered respiratory insufficiency and left pleural drainage was replaced in the suspicion of relapsing pneumothorax; subsequent CXR (C) clearly demonstrated the presence of BDI with intra-thoracic gastric herniation (circle). BDI: Blunt diaphragmatic lesions; CXR: Chest X-ray; CT: Computed tomography; ED: Emergency Department.